I've been wanting to write an article on this subject for a long time, but didn't have time to do the research - and then I found a book which had done that research for me! Thus, most of the information for this article is taken from "Mainstreaming Midwives: The Politics of Change," edited by Robbie Davis-Floyd and Christine Barbara Johnson. I will be reviewing this book (in glowing terms!) very soon as well, but I wanted to write this article as soon as I could, as I need to return the book to my midwife on Sunday. So here goes!
Midwives are still, for the most part, America's best-kept secret in terms of health-care practitioners. When I was in Border's last year buying a copy of Elizabeth Davis' "Heart and Hands," the clerk said, "Do midwives even still exist? You're kidding!" Yes, Virginia, there really are midwives! Alive and thriving (and growing!) but unfortunately still attending only about 1% of all births.
However, for those of us who do know about midwives, the sheer number of midwife "titles" can be overwhelming and confusing - certified nurse midwife, certified midwife, certified professional midwife, lay midwife, licensed midwife - and more!
The purpose of this article will be to briefly (and incompletely, I'm afraid) examine the history of American midwifery and throw some light onto the differentiations between types of American midwives.
The history of American midwifery is a long and conflicted story which has unfortunately not always been a positive one. The story of midwives in the early part of the 20th century was marked by persecution and witch-hunts (still going on, unfortunately), and in the latter part of the century was marked with internal strife and divisions which led to midwives oftentimes fighting amongst themselves over ideological differences rather than uniting as a common front.
To begin....
In 1900, only 1% of births took place in hospitals. By 2000, those numbers had reversed, with only 1% of births taking place at home. How and why did this change occur? It occurred because a decision was made by the medical profession that birth was profitable and midwives, therefore, needed to go. A massive propaganda campaign was launched against midwives, with midwives portrayed as dirty, ignorant, old-fashioned, archaic, disease-carrying crones who were unsafe care-givers and who were practicing medicine illegally. This campaign was especially effective with immigrant mothers, who wanted to forsake everything having to do with the Old World and become as "American" as possible - and being "American" soon came to mean having a male obstetrician delivering one's babies in a hospital (and giving formula, etc.).
Unlike European midwives, who were well-organized in trade unions and professional organizations and were able to protect themselves and their profession, American midwives were not well-organized, or even organized at all. They were isolated, working within their own ethnic groups, with little to no communication with other midwives, and had no professional organizations. To put it vulgarly, they were sitting ducks who went down with one shot - they were not able to resist the combined efforts of the government and the medical establishment who were bent on eradicating them.
Of course, lay homebirth midwives never completely disappeared - but their numbers were greatly reduced and they were forced to practice underground.
Midwives who wished to continue practicing legally made a monumental decision, one that affects American midwifery to this day - they decided to unite with the respected position of nursing. Thus, in 1925 Mary Breckenridge formed the first organization uniting nursing and midwifery, the Frontier Nursing Service, bringing midwifery care to the Appalachian poor, and the profession of nurse-midwifery (eventually producing the certified nurse-midwife) was born.
In 1930 a second nurse-midwifery institution was opened - the Lobenstine Clinic in New York City, later home of the nation's first nurse-midwifery program. This clinic met the needs of poor, inner-city women and was staffed by nurse-midwives.
Initial efforts of nurse-midwives met with success. There was a notable lack of opposition from obstetricians because of the clientele that the midwives were serving - most obstetricians did not want the "down and dirty" jobs of providing care to the poorest-of-the-poor or to mothers in extreme rural districts. Midwifery survived by meeting needs no one else wanted to meet, and by finding a niche for itself there. Nurse-midwives also survived by proving their worth with excellent statistical results and by finding small numbers of physicians sympathetic to their cause who would support them and work with them.
Thus, nurse-midwifery gained a foot-hold in American maternity care, but growth for the profession was extremely slow. Additionally, many of America's nurse-midwives were lost to the system in that they decided to pursue careers overseas in missions work or left the nurse-midwifery profession altogether and worked in health-related fields.
Also, at this time nurse-midwifery was not synonymous with hospital birth, as it often is today - many nurse-midwives attended home births or worked in maternity centers. Thus hospital births were attended primarily by obstetricians.
In 1929, six nurse-midwives from the Frontier Nursing Service formed the American Association of Nurse-Midwives. This was not a professional organization, but an attempt to focus on providing better maternity care for women and babies.
However, the lack of a true professional organization for the nurse-midwives was soon felt. Unable to find a good niche for themselves in other health-care professional organizations, nurse midwives in 1955 formed the American College of Nurse Midwives (ACNM), still extant today. Their initial goals were to develop educational standards, sponsor research and participate in the International Confederation of Midwives. The formative purpose of the ACNM was to promote and protect the profession of nurse-midwifery, and in doing so it was an enormous step forward for midwifery.
At the same time, the baby boom was occurring, and city hospitals were overwhelmed with the sheer number of birthing mothers. To reduce costs and meet staffing needs, hospitals began to hire large numbers of nurse-midwives, and thus the transition of nurse-midwifery into a hospital-based instition began - and has really never reversed. Nurse-midwives now overwhelmingly work in hospitals and attend hospital births.
There were several positives to this shift into hospital-based work. Nurse-midwives were now able to serve more women, able to increase their knowledge-base by serving cases with complications (which in homebirths would have been risked out to hospital care, as they are today), able to better serve the needs of the poor, and also able to more firmly establish themselves in the maternity system. Because of the shift into hospital-based work, more nurse-midwifery schools opened and there was steady employment for larger numbers of nurse-midwives.
However, there was also a negative side to the shift into hospitals. Primarily this was seen in nurse-midwives' loss of autonomy and increasing subordination to doctors. Rather than always being independent practitioners in charge of women's health-care, nurse-midwives were now subordinate to the doctor in charge, and in many cases became nothing more than glorified obstetrical nurses (something that holds true today).
In-hospital conflicts for nurse-midwives have never disappeared. Although nurse-midwives are still entrenched in the hospital system, they are still often treated as nurses and are under the authority of physicians. Additionally, because of intervention-heavy hospital protocols, they are often forced to practice against the midwifery model of care, resulting in births that are midwife-atended but still heavy on unnecessary and dehumanizing interventions. Also, the training and hospital work of nurse-midwives can unfortunately produce midwives who are more obstetrically-minded than midwifery minded (called "med-wives") who are no longer practicing according to midwifery standards but have conformed in both thought and behavior to the model of mainstream birth as a medical event. Thus, although nurse-midwives are able to provide hospital midwifery birth services to women who want hospital births (which is the majority of modern American women), their practice and sometimes their beliefs can be negatively altered by their chosen place of practice.
For nurse midwives, the shift to hospital-based work was so complete that in 1973 the ACNM published a statement against homebirth, saying that the hospital was:
"the preferred site for childbirth because of the distinct advantageto the physical wefare of mother and infant" (ACNM 1973, quoted in Rooks 1997:67, quoted in Davis-Floyd 2006:36)
(This statement was retracted in 1980.)
During the 1960's and 1970's the profession of nurse-midwifery made great strides. Although in 1963 there were only forty nurse-midwives practicing in the United States, the ACNM was making great strides in terms of developing the profession of nurse-midwifery. In 1965 the ACNM developed their accreditation process, and by 1970 it was administering national certification and accreditation for all nurse-midwifery programs. In 1978 the ACNM defined the core competencies for nurse midwifery (core competencies are "the fundamental knowledge, skills, and behaviors that are the expected outcomes of..... education", p. 38) and by 1980 there were nineteen nurse-midwifery education programs, with nurse-midwifery legal and protected in 41 states. Nurse-midwives attended approximately 1% of all American births.
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And now we examine the other side of the coin: We will examine the story of the lay midwife, also called the direct-entry midwife (DEM) who is not a trained nurse and who often learned her trade by apprenticeship.
In the 1960's and 1970's there was a reactionist movement (mixed together with the countercultural and feminist movements) against the extreme medicalization and often brutalization of birth in American hospitals. At the time women were isolated from family during birth, physically restrained, and forcibly anaesthetized during the birth process. Both mothers and babies suffered from the drugs used on them, breastfeeding was discouraged, and babies were isolated in newborn nurseries.
"From the 1930's to the 1970's scopolamine was heavily employed. A psychedelic amnesiac that was supposed to take away memory, this drug often did not render women unconscious during birth, but rather made them wild. They were strapped down with lamb's wool bands (which did not leave marks on thier arms) and often left alone to scream until the baby finally came; many women were subsequently haunted by spotty nightmarish memories. Technological interventions such as forceps and episiotomies became increasingly common as humanistic care for birthing women became increasingly rare." (p. 38)
Some mothers, helped by certified nurse-midwives, tried to change and improve hospital birth for the better. Benefits gained during this time included getting fathers into the delivery room, permitting mothers to labor without being restrained and the promotion of conscious birth and breastfeeding. However, change was limited and slow.
Frustrated with slow change, women within this movement began to give birth at home. Since there were oftentimes no midwives to attend them, these women became each other's midwives - attending births of friends and families and slowly building their knowledge-base by experience and self-teaching. They became the first generation of the resurgence of the lay midwife. As time went by lay midwifery grew in numbers and knowledge, formed relationships and began producing literature, such as Ina May Gaskin's "Spiritual Midwifery."
Lay midwifery was not well-received by nurse-midwifery. To put it succinctly, "They're destroying everything we've worked for!" Nurse midwives stood for credibility, professionalism, standards of care, medical orientation, protocols, etc. Lay midwifery stood for women's rights and natural birth and was often hippie-ish and spiritual in nature (especially in the early days), making nurse-midwives fear for the credibility of midwifery professionalism. Thus began a conflict between schools of thought in American midwifery which has never been completely healed, and which has often caused deep and bitter resentment and divide between the two camps. (In fact, the divide and the conflict has often been so deep and problematic that American midwifery has been used by other nations, Canada in particular, as a model of how not to do midwifery.)
In 1981, Sister Angela Murdaugh, then-president of the ACNM, met with a group of lay midwives and, in a controversial move, urged them to organize and create principles of practice by which lay midwifery could be organized and made more professionals. Sister Angela received a great deal of opposition from within her own ranks in the ACNM - many nurse-midwives felt that lay midwives should either be discouraged from practicing altogether or encouraged to become nurse-midwives and join the ACNM. However, Sister Angela's courageous move gave impetus to the lay midwifery movement and started wheels turning for the organization of lay midwifery. However, the two professions remained separate and did not in any way unite. Although the ACNM had in 1980 made a counter-statement now supporting homebirth, the ACNM did not open to lay midwifery until 1994 - by which time lay midwifery was already well organized on its own and did not need the ACNM's help.
And so the stage was set for one of the biggest accomplishments for lay midwifery in America - the formation of the Midwives Alliance of North America (MANA), a coalition formed by lay midwives and some sympathetic nurse-midwives. There was no nursing requirement for membership, as nursing was seen by nurse-midwives to be detrimental to the practice of true midwifery, the two having completely different philosophies and knowledge-bases.
"As these original lay midwives became more sophisticated in their understanding of the details of medical training an dpractice, they saw quite clearly that what they were seeing at homebirths often did not reflect what they were reading about and seeing in hospital birth. Understanding that they were developing a different knowledge system, over time they sought to develop educational methods and programs that would perpetuate that systyem, and to avoid incorporation into the more medicalized nurse-midwifery approach." (Anne Fry, quoted on p. 43)
MANA and lay midwifery thrived despite ill-wishes of the medical and nurse-midwifery community and despite active persecution law enforcement. Occasionally supportive CNM's joined MANA as well (MANA valued inclusivity and welcomed nurse-midwives).
However, MANA was not then an official professional organization because, at the time, it had no ability to enforce its core competencies as educational requirements, and thus was open to the accusation of illegitimacy as an professional organization.
In the late eighties and early nineties, meetings called the Carnegie Meetings were held between MANA and the ACNM to try to create much-needed unity. While each deemed that their core competencies were equivalent, the philosophical divide between the two was too great to achieve unity.
One of the most deeply divisive issues at hand was that of apprenticeship. ACNM holds that apprenticeship is an invalid and incomplete method of training, and that only a university degree can validly qualify a midwife. MANA holds that apprenticeship is a valid route to midwifery training, and furthermore, that it is an essential method that preserves the midwifery model of care, and additionally, that university training in a traditional setting can be destructive to the formation of holistically-minded midwives.
(Speaking as a woman who was cared for by apprenticeship-trained midwives, I wholeheartedly agree with MANA's position and view apprenticeship as vital and essential to midwifery education. I now would not want to be under the care of a midwife trained any other way. - Author)
In 1991 MANA created the Midwifery Education Accreditation Counsel (MEAC) which was recognized by the US Department of Education in 2001, comparable to the ACNM's Department of Accreditation (DOA) which was recognized by the Department of Education in 1982. Thus MANA was well on its way to becoming more "professional." MANA recognized the need for a mechanism to prove the competency of its midwives. Most lay midwives had already dropped the term "lay midwife" for the term "direct-entry midwife" (DEM), by which they meant apprenticeship-trained or non-university-trained midwives. Thus, by 1994, MANA's daughter organization the North American Registry of Midwives (NARM) had developed into a testing and certifying agency and had developed the Certified Professional Midwife (CPM) credential, a credential that recognized formal training, self-training, apprenticeship training and portfolio work for credentialing as well as designing the NARM written and practical exam for licensing.
"CPM certification is competency based; where a midwife gains her knowledge, skills, and experience is not th eissue - the fact that she has them is what counts." (p. 53)
At the same time, certified nurse-midwives were reexamining their self-identity. Many wished to break with nursing, for some of the following reasons: (1) they were tired of being treated as glorified nurses, (2) they desired autonomy from doctors and state nursing boards, (3) Physicians Assistants had started attending births, and (4) the realization that only some nursing knowledge is needed for midwifery. Nurse-midwives thus created the Certified Midwife (CM) credential, a certification that maintains the tradition and philosophy of nurse-midwifery without the nursing requirement. Nurse-midwives refer to the CM as their direct-entry midwife, creating some confusion as to what a DEM really is.
In summary, America has two basic types of midwives:
Type #1: Nurse Midwife
Includes: Certified Nurse-Midwife, Certified Midwife
Professional Organization: ACNM (American College of Nurse Midwives)
Accreditation Organization: DOA (Department of Accreditation)
Location of Practice: Mostly hospital, occasionally birth centers and home
Type #2: Lay or Direct-Entry Midwife (DEM)
Includes: Lay Midwife, Licensed/Unlicensed Midwife, Certified Professional Midwife
Professional Organization: MANA (Midwives Alliance of North America)
Accreditation Organization: MEAC (Midwifery Education Accreditation Counsel)
Location of Practice: Home (may not practice in-hospital in America)
A few other notes:
The legality of homebirth DEM's differs greatly from state to state. In about ten states (poor pitiable places) lay midwives' work is 100% illegal, and midwives must work underground. In other states it is "a-legal" - neither legal nor illegal, but midwives maintain a tenuous position of being open to prosecution in cases of poor neonatal or maternal outcomes. In other states (such as Arizona, hurray!) midwives are legal and may practice openly, though they still deal with backward attitudes in hospitals and from doctors.
Midwives' legal scope of practice varies widely by state as well. For example, homebirth midwives may deliver twins in California, but not in Arizona; they may deliver VBAC babies in Utah, but not in Arizona.
Additionally, some states allow midwives to practice while unlicensed, such as Utah and Oregon (Arizona doesn't).
I'd like to look at a few other terms:
"granny midwife" - a term for an elderly female midwife, usually black, who served her ethnic community, generally in the deep south. These women were effectively put out of business by the health departments.
"plain midwife" - a midwife, usually unlicensed and unregistered, who works (often unpaid) among her religious or ethnic community. Examples are Amish & Mennonite midwives, and midwives who serve Mormon communities and Christian Scientist communities
"renegade midwife" - there are a couple of different types here:
(!) a midwife who practices without sufficient training and is dangerous to the community - few and far between, but it does happen. These are not licensed midwives, but unlicensed lay midwives who branch out on their own when they should still be studying or learning under apprenticeship
(2) a midwife who practices outside the legal scope of practice for her region but is generally considered responsible by the midwifery community. For example, a midwife might attend VBAC homebirths, which are considered safe by midwives (VBAC's are generally only risky when labor-augmenting drugs are used) but are often illegal by state licensure laws
(3) a midwife who attends women at home in risky situations, such as triplets, etc. These women can be risk-takers but are often valued by the community as midwives who keep options open for birthing women. (I, for example, support a woman's right to birth how she wishes, even if a hospital birth is medically indicated. But midwives who don't want to endanger their licensing or ability to practice are often reluctant to take on such mothers, even though they support mothers' rights. This type of renegade midwife ensures that mothers retain their rights even when other homebirth midwives have to turn them away. - Author) However, they can give the midwifery community a bad name.
Midwifery in America is a constantly growing, changing, evolving profession, and one which I am glad that I now know of! I love midwives and am so happy to have several among my close acquaintance.
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That's about it! If you see any omissions or errors, please contact me, as I want the above to be as accurate as possible.
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Postscript on January 5th, 2009:
The Mommy Blawger sent in the following comments, which I wanted to add below, as they're both very pertinent points which I should have included in the article:
"I will make just one or two additions. First, since the rise of the CPM credential, the term "lay midwife" has taken on an almost pejorative meaning, and is almost exclusively used (at least by midwives) to refer to women without any formal midwifery training or credential.
"Second, many (including myself) believe that there is no such thing as an "alegal" state. Either a state recognizes/permits/regulates direct-entry midwifery, or it doesn't. In a state where midwifery is not "authorized", even if there is no statute specifically prohibiting DEMs, a midwife runs the risk of being charged with practicing medicine or nurse-midwifery without a license, or a number of related offenses. You can see that in states such as Pennsylvania, which was formerly described as "alegal", it took only one bad outcome for the powers-that-be to start actively prosecuting midwives.
"Your readers may be interested in this resource for more on the legal status of midwifery:
http://fromcallingtocourtroom.net/
Friday, October 24, 2008
Wednesday, October 22, 2008
Mainstream Birth: It's Not Just the Docs
Today I was sitting in a public place (researching midwifery, oddly enough) and happened to overhear a somewhat saddening conversation between two women, one of whom was pregnant. I'm going to try to piece it together here for you, with details obscured... I'm not guaranteeing accuracy, as this is from memory, but you'll get the gist.
Woman (not pg): So, when's your due date?
Pregnant Mother: {mentions date}
Woman: Well, my last couple of babies were cesareans. We had my last one two weeks early so his birthday wouldn't be too close to Christmas.
Pregnant Mother: Oh, that's cool!
Woman: Yeah, I mean, when their birthdays are on Christmas, they don't get the special treatment that everyone else gets. My {mentions relative} has two kids who were born just before Thanksgiving and just after Christmas, and they never get real birthday parties. And I'm thinking, "Gee, couldn't you have planned better than that?" Those poor kids!
Pregnant Mother: That's a good idea. I'll keep it in mind.
My goodness! Scheduled prematurity so your child can have "real birthday parties"???? Is this what we're coming to? What ever happened to letting a baby come when he is ready?
As much as we vilify ACOG (and they definitely deserve some vilification), we must, as women, take responsibility for the birth situation as well. Unethical birth practices only exist because we submit to them and sometimes actively encourage them by willing participation and willing ignorance. If we refused to participate, hospitals and doctors would follow suit.
Food for thought!
Woman (not pg): So, when's your due date?
Pregnant Mother: {mentions date}
Woman: Well, my last couple of babies were cesareans. We had my last one two weeks early so his birthday wouldn't be too close to Christmas.
Pregnant Mother: Oh, that's cool!
Woman: Yeah, I mean, when their birthdays are on Christmas, they don't get the special treatment that everyone else gets. My {mentions relative} has two kids who were born just before Thanksgiving and just after Christmas, and they never get real birthday parties. And I'm thinking, "Gee, couldn't you have planned better than that?" Those poor kids!
Pregnant Mother: That's a good idea. I'll keep it in mind.
My goodness! Scheduled prematurity so your child can have "real birthday parties"???? Is this what we're coming to? What ever happened to letting a baby come when he is ready?
As much as we vilify ACOG (and they definitely deserve some vilification), we must, as women, take responsibility for the birth situation as well. Unethical birth practices only exist because we submit to them and sometimes actively encourage them by willing participation and willing ignorance. If we refused to participate, hospitals and doctors would follow suit.
Food for thought!
Tuesday, October 21, 2008
Childbirth in Vintage Movies: "Blue Skies"
I had an interesting experience the other day - getting to watch a vintage childbirth scene from a 1946 film, "Blue Skies" with Bing Crosby and Fred Astair.
First of all, as an aside, I should say that I now understand why a movie with two such phenomenal actors is not well-known - talk about overdone!! This was supposed to be Fred's last movie (it wasn't), so they pulled out all the stops for it - they had a song and/or dance number about every five minutes. Literally. It was extremely tiresome! Combined with a weak plot, it made for a movie that we probably won't be watching again.
Anyhow, there was an unexpected childbirth scene in the movie that I found very interesting. Here's what you see: Bing Crosby pacing with his friend in a lobby in front of a newborn nursery. The nurse comes out with a baby and shows it to him, then takes it away. The doctor comes out and Bing immediately says, "Can I see her, doctor?" The doctor says, "Well, I don't know - she's still kind of sleepy." He rushes in anyway, in time for a conversation with a half-unconscious wife. The next scene is of them giving a bottle to the baby.
Okay, let's unpack this for just a minute. Here's the reality of what would have happened:
During labor, the wife (Joan) would have been isolated from her family and then doped out of her mind with various drugs, including scopolamine. She would have been strapped down to a delivery table in the lithotomy position (flat on her back, head lower than her legs, legs tied into stirrups). For the actual delivery she would have been (either willingly or forcibly) drugged into complete unconsciousness. The doctor would have cut one heck of an episiotomy, dragged a near-unconscious infant out with forceps, and spanked it vigorously to it breathing (a drugged mother is a drugged baby) and then toted it off to the newborn nursery. Not only would the mother not have been conscious for the birth, but she probably wouldn't have seen her baby for some time (and would be too drugged out to care). She would have been discouraged from breastfeeding and told to give the always-superior formula.
The arrogance of humanity astounds me. God has given us a perfect process in human childbirth which is self-contained and needs (in most cases) only loving support and encouragement. But in every age since we've been able to do so (including the present time) man has with the utmost conceit assumed that a perfect process needs improvement by humanity, and thus has created such atrocities as scopolamine-drugged births in the 1950's and a now 32% cesarean rate in the 2000's. Sad.
This just makes me mad because I know how important a woman's birth experiences are to her. Rather than go on a rant, I'll just refer you to my entry below this one.
A couple of years ago, I would have seen this scene and thought it merely sweet. After all, they abound throughout film - "I Love Lucy," etc. And modern childbirth scenes in the media are really no better. There's always the emergency situation, the "rescue" by the godlike doctor, the unnecessary interventions accepted by unknowing mothers as good and needed. Gee whiz, you'd think we could improve out of this mess!
Enough grousing! Back to what I should be doing!
First of all, as an aside, I should say that I now understand why a movie with two such phenomenal actors is not well-known - talk about overdone!! This was supposed to be Fred's last movie (it wasn't), so they pulled out all the stops for it - they had a song and/or dance number about every five minutes. Literally. It was extremely tiresome! Combined with a weak plot, it made for a movie that we probably won't be watching again.
Anyhow, there was an unexpected childbirth scene in the movie that I found very interesting. Here's what you see: Bing Crosby pacing with his friend in a lobby in front of a newborn nursery. The nurse comes out with a baby and shows it to him, then takes it away. The doctor comes out and Bing immediately says, "Can I see her, doctor?" The doctor says, "Well, I don't know - she's still kind of sleepy." He rushes in anyway, in time for a conversation with a half-unconscious wife. The next scene is of them giving a bottle to the baby.
Okay, let's unpack this for just a minute. Here's the reality of what would have happened:
During labor, the wife (Joan) would have been isolated from her family and then doped out of her mind with various drugs, including scopolamine. She would have been strapped down to a delivery table in the lithotomy position (flat on her back, head lower than her legs, legs tied into stirrups). For the actual delivery she would have been (either willingly or forcibly) drugged into complete unconsciousness. The doctor would have cut one heck of an episiotomy, dragged a near-unconscious infant out with forceps, and spanked it vigorously to it breathing (a drugged mother is a drugged baby) and then toted it off to the newborn nursery. Not only would the mother not have been conscious for the birth, but she probably wouldn't have seen her baby for some time (and would be too drugged out to care). She would have been discouraged from breastfeeding and told to give the always-superior formula.
The arrogance of humanity astounds me. God has given us a perfect process in human childbirth which is self-contained and needs (in most cases) only loving support and encouragement. But in every age since we've been able to do so (including the present time) man has with the utmost conceit assumed that a perfect process needs improvement by humanity, and thus has created such atrocities as scopolamine-drugged births in the 1950's and a now 32% cesarean rate in the 2000's. Sad.
This just makes me mad because I know how important a woman's birth experiences are to her. Rather than go on a rant, I'll just refer you to my entry below this one.
A couple of years ago, I would have seen this scene and thought it merely sweet. After all, they abound throughout film - "I Love Lucy," etc. And modern childbirth scenes in the media are really no better. There's always the emergency situation, the "rescue" by the godlike doctor, the unnecessary interventions accepted by unknowing mothers as good and needed. Gee whiz, you'd think we could improve out of this mess!
Enough grousing! Back to what I should be doing!
Tuesday, October 14, 2008
Why Natural Childbirth?
I wanted to share a few thoughts on this topic - in other words, why would any sane woman in the 21st century choose natural childbirth when there are so many chemical methods for pain relief?
(This is separate from an upcoming entry, "Why Homebirth?" which is related but separate. One can have natural birth at home or in hospital (although it's much tougher in hospital), but the benefits of homebirth aren't transferable to a hospital - so I'll write on those later.)
What is natural birth? Most obviously it is birth that is untainted by artificial chemicals, either in the form of induction/augmentation agents (pitocin, misoprostol, etc.), or chemical pain relief (epidural, spinal, narcotics, etc.). Actually, I should correct myself... There are different definitions, depending on who you ask. In the mainstream birth world, "natural birth" generally just means birth without chemical pain relief, regardless of whether or not the mother was artificially induced or had an artificially augmented labor. "Pure birth," which I experienced and which I highly recommend, is the technical term for birth which is completely free from any chemical interference (and generally other externals such as an IV or continuous fetal monitoring).
There are deeper facets to natural childbirth, which would include things like natural birth positions (squatting, standing, etc.), immediate skin-to-skin contact with baby, delayed cord clamping, continuous labor support, no directed pushing, etc.). However, for the purpose of this entry I am going to focus on the "chemical" parts - I will define natural birth as birth in which the mother receives no pain medication, and ideally no labor induction or labor augmentation drugs. (With a national cesarean rate of about 32% and a national induction rate of around 40%, you can bet that any of the above is pretty stinking rare.)
First, let's get the obvious out of the way. Natural birth is way better for baby and mother. This is not hard to understand or to prove. Fewer cesareans (a first-time mother with an epidural is roughly four times as likely to end up with a cesarean as is an unmedicated mother), fewer long-term health effects on mom and baby, better bonding, you name it. The health benefits of natural birth for mother and baby are endless. This point isn't even up for debate, it's been so well-proven. Period. End of story.
But there's a bigger story.
Let me tell you my own experience, briefly.
I hated childbirth. Every minute of it. It started out uncomfortable, and worked up to excruciating - and stayed there. I basically screamed for the last six hours of it. It was hell on earth. In fact, as soon as it was over, I turned to my husband and told him that childbirth should be a Christian missionary's best friend, because there is no closer analogy to hell on earth. I didn't even experience the classical "birth ecstasy" of the unmedicated mother - the "my baby, my baby!" moment. I just wanted to crawl in a hole and die. I felt awful, birthing the placenta was also excruciating, and I immediately had afterpains so badly that I couldn't stand to nurse (and they hung around for over six weeks, dang it!!). If you look at my birth pictures, I am not even smiling because I was exhausted and in pain.
I'm not saying this to be discouraging - I just want the reader to know that I DO know how bad childbirth hurts. It hurts big-time. For me it was eighteen hours of torture. If I had been in the hospital I would have requested an epidural about ten hours before our son was born (another reason I'm glad I wasn't in the hospital!). Many women say that they experience childbirth as spiritual, that that they find "their rhythm," etc. I didn't. It was horrible start-to-finish.
Then, the intelligent reader asks, why are you now a proponent of natural childbirth/homebirth with a blog devoted exclusively to the subject? Are you stark, raving mad?
Let me continue with my story.
It is hard to explain this, but in the days after my birth I experienced the most amazing spiritual transformation. Next to Christian salvation, it has been the most amazing life-change - one that I could not have anticipated, and one that I cannot even fully describe. I will say this, though - Who I was before natural childbirth was not who I was after experiencing natural childbirth. It was a complete transformation, one which still awes and amazes me and which is completely beyond my understanding.
For one thing, I am now much more self-confident. I know that I am competent and able to do whatever I need, because I have done the most difficult thing that any human being can do. My body is amazing, and frankly, so am I! I withstood that tremendous pain and got through it - and I can do ANYTHING now. I have lost all amazement for athletic feats. Someone climbed Mt. Everest? Ran a 3-minute mile? GIVE ME A BREAK!!! I came through natural childbirth!!!!!
For another thing, natural childbirth also greatly healed my self-image. I, like the other 99.99% of American women who have been brainwashed into only seeing beauty in quasi-anorexia, definitely had issues with seeing my body as anything but flawed. But natural childbirth showed me the brilliant complexity and functionality of my body in ways that I could never have imagined. My body is "wonderfully and marvelously made," and I gained immense respect for it and for myself. Now, post-pregnancy, my body has way more issues than it did before - stretch marks galore, ten extra pounds and proportions so radically different I probably wouldn't recognize myself from before. But my self-image is much more positive and affirming, and I have learned to be grateful for the amazing things that my body can do - regardless of whether or not I look like a supermodel.
For another thing, I feel that in many ways that natural childbirth was truly my "coming of age." This was truly that transformation point for me. It wasn't puberty, high school graduation, sweet 16 (or 18 or 21), first date, first kiss, marriage, sex, pregnancy - no way. Not even close. It was natural childbirth. It was truly the coming of age for me. I can't say how or why, and I certainly didn't expect it. It just was. Some part of me just matured and ripened over that 24-hour period and emerged as a woman. I believe that there is some part of woman's soul that is tied to the experience of childbirth. If you ask almost any woman who has experienced natural birth, she will generally agree with this without even thinking about it (and will often go into detail about it!).
I need to add something here: It's hard writing the above, because there are some women who can't give birth, due to singleness or infertility. One of my close friends is dealing with longterm infertility right now, and it is a heart-wrenching process (another proof that birth is important to women!). I believe that that things are different spiritually for women who cannot physically give birth - that God provides other methods of maturation and self-discovery and spiritual growth. God is a God of individuals - no one is left out of spiritual growth opportunities in the economy of God. But speaking for myself, I know that there was a depth to my soul that could only be reached with unmedicated birth. And that's something I never would have guessed before my birth experience.
Some might say, "All of the above was just from childbirth - not natural childbirth." Nope, not at all. The pain of labor and birth was inextricably wrapped up in transformative effects of both. For me, childbirth was a "baptism of pain." It taught me to reach out to other women, my midwives and doula, and to see how much true love and friendship there can be among female friends, and how comforting women can be to one another during birth. It taught me compassion for other birthing women and for people who must endure pain. It taught me the great kinship that I experience with women throughout the ages of history who have endured the same thing to bring the human race into existence. It taught me to value my baby greatly, because he was birthed through my pain - and is unutterably precious.
From a Christian perspective, experiencing natural childbirth gave me a deeper understanding into the meaning of the Bible passage, "But women will be saved through childbearing" (I Tim 2:15) This is not referring to salvation from eternal death, but to something quite different. There are many different interpretations and lines of thought on this passage. But to me it has become clear that God has used the "curse" of the Fall (for man, hard and unproductive labor in their lifework, for women, pain in childbirth) to also be our greatest blessings. Who would deny that men find some of their greatest blessings and self-identity through hard work and discovery/industry/building/etc.? And I know now that women can find some of their deepest grounding, meaning, and self-identity in the pain of childbirth. Our curse has become our blessing.
But frankly, there is just so much to this transformation that I just can't describe it. If anyone would like to write a comment and give me a hint as to what I ought to be writing, I would appreciate it and will add it in! I can only say that natural, drug-free childbirth was an earth-shattering, life-changing transformation that will be with me for the rest of my life. I am even eager to go through it again, just because of that. And I have the deepest sorrow for all the women who do not get to experience this transformation because they have been cut open or drugged. I want every woman to experience this tremendous blessing and transformation - and that's one of the main reasons this blog is here.
Having a baby is more than a messy, unpleasant process that one must endure to get a baby. When people hear a horrible birth story and say, "Well, at least you have a healthy baby! That's what matters!" they completely miss the point. A woman's birth stories are part of her identity and will affect her profoundly for the rest of her life. Many women spend years and subsequent births trying to heal from cruel and demeaning treatment during previous births, or births that were in one way or another traumatic. Yes, the baby is the most important thing, but a mother's birth experience is a close second. There is nothing like it in the world, and I hope to spend the rest of my life promoting natural birth for this reason.
Email me with comments and questions!
Love,
Diana
(This is separate from an upcoming entry, "Why Homebirth?" which is related but separate. One can have natural birth at home or in hospital (although it's much tougher in hospital), but the benefits of homebirth aren't transferable to a hospital - so I'll write on those later.)
What is natural birth? Most obviously it is birth that is untainted by artificial chemicals, either in the form of induction/augmentation agents (pitocin, misoprostol, etc.), or chemical pain relief (epidural, spinal, narcotics, etc.). Actually, I should correct myself... There are different definitions, depending on who you ask. In the mainstream birth world, "natural birth" generally just means birth without chemical pain relief, regardless of whether or not the mother was artificially induced or had an artificially augmented labor. "Pure birth," which I experienced and which I highly recommend, is the technical term for birth which is completely free from any chemical interference (and generally other externals such as an IV or continuous fetal monitoring).
There are deeper facets to natural childbirth, which would include things like natural birth positions (squatting, standing, etc.), immediate skin-to-skin contact with baby, delayed cord clamping, continuous labor support, no directed pushing, etc.). However, for the purpose of this entry I am going to focus on the "chemical" parts - I will define natural birth as birth in which the mother receives no pain medication, and ideally no labor induction or labor augmentation drugs. (With a national cesarean rate of about 32% and a national induction rate of around 40%, you can bet that any of the above is pretty stinking rare.)
First, let's get the obvious out of the way. Natural birth is way better for baby and mother. This is not hard to understand or to prove. Fewer cesareans (a first-time mother with an epidural is roughly four times as likely to end up with a cesarean as is an unmedicated mother), fewer long-term health effects on mom and baby, better bonding, you name it. The health benefits of natural birth for mother and baby are endless. This point isn't even up for debate, it's been so well-proven. Period. End of story.
But there's a bigger story.
Let me tell you my own experience, briefly.
I hated childbirth. Every minute of it. It started out uncomfortable, and worked up to excruciating - and stayed there. I basically screamed for the last six hours of it. It was hell on earth. In fact, as soon as it was over, I turned to my husband and told him that childbirth should be a Christian missionary's best friend, because there is no closer analogy to hell on earth. I didn't even experience the classical "birth ecstasy" of the unmedicated mother - the "my baby, my baby!" moment. I just wanted to crawl in a hole and die. I felt awful, birthing the placenta was also excruciating, and I immediately had afterpains so badly that I couldn't stand to nurse (and they hung around for over six weeks, dang it!!). If you look at my birth pictures, I am not even smiling because I was exhausted and in pain.
I'm not saying this to be discouraging - I just want the reader to know that I DO know how bad childbirth hurts. It hurts big-time. For me it was eighteen hours of torture. If I had been in the hospital I would have requested an epidural about ten hours before our son was born (another reason I'm glad I wasn't in the hospital!). Many women say that they experience childbirth as spiritual, that that they find "their rhythm," etc. I didn't. It was horrible start-to-finish.
Then, the intelligent reader asks, why are you now a proponent of natural childbirth/homebirth with a blog devoted exclusively to the subject? Are you stark, raving mad?
Let me continue with my story.
It is hard to explain this, but in the days after my birth I experienced the most amazing spiritual transformation. Next to Christian salvation, it has been the most amazing life-change - one that I could not have anticipated, and one that I cannot even fully describe. I will say this, though - Who I was before natural childbirth was not who I was after experiencing natural childbirth. It was a complete transformation, one which still awes and amazes me and which is completely beyond my understanding.
For one thing, I am now much more self-confident. I know that I am competent and able to do whatever I need, because I have done the most difficult thing that any human being can do. My body is amazing, and frankly, so am I! I withstood that tremendous pain and got through it - and I can do ANYTHING now. I have lost all amazement for athletic feats. Someone climbed Mt. Everest? Ran a 3-minute mile? GIVE ME A BREAK!!! I came through natural childbirth!!!!!
For another thing, natural childbirth also greatly healed my self-image. I, like the other 99.99% of American women who have been brainwashed into only seeing beauty in quasi-anorexia, definitely had issues with seeing my body as anything but flawed. But natural childbirth showed me the brilliant complexity and functionality of my body in ways that I could never have imagined. My body is "wonderfully and marvelously made," and I gained immense respect for it and for myself. Now, post-pregnancy, my body has way more issues than it did before - stretch marks galore, ten extra pounds and proportions so radically different I probably wouldn't recognize myself from before. But my self-image is much more positive and affirming, and I have learned to be grateful for the amazing things that my body can do - regardless of whether or not I look like a supermodel.
For another thing, I feel that in many ways that natural childbirth was truly my "coming of age." This was truly that transformation point for me. It wasn't puberty, high school graduation, sweet 16 (or 18 or 21), first date, first kiss, marriage, sex, pregnancy - no way. Not even close. It was natural childbirth. It was truly the coming of age for me. I can't say how or why, and I certainly didn't expect it. It just was. Some part of me just matured and ripened over that 24-hour period and emerged as a woman. I believe that there is some part of woman's soul that is tied to the experience of childbirth. If you ask almost any woman who has experienced natural birth, she will generally agree with this without even thinking about it (and will often go into detail about it!).
I need to add something here: It's hard writing the above, because there are some women who can't give birth, due to singleness or infertility. One of my close friends is dealing with longterm infertility right now, and it is a heart-wrenching process (another proof that birth is important to women!). I believe that that things are different spiritually for women who cannot physically give birth - that God provides other methods of maturation and self-discovery and spiritual growth. God is a God of individuals - no one is left out of spiritual growth opportunities in the economy of God. But speaking for myself, I know that there was a depth to my soul that could only be reached with unmedicated birth. And that's something I never would have guessed before my birth experience.
Some might say, "All of the above was just from childbirth - not natural childbirth." Nope, not at all. The pain of labor and birth was inextricably wrapped up in transformative effects of both. For me, childbirth was a "baptism of pain." It taught me to reach out to other women, my midwives and doula, and to see how much true love and friendship there can be among female friends, and how comforting women can be to one another during birth. It taught me compassion for other birthing women and for people who must endure pain. It taught me the great kinship that I experience with women throughout the ages of history who have endured the same thing to bring the human race into existence. It taught me to value my baby greatly, because he was birthed through my pain - and is unutterably precious.
From a Christian perspective, experiencing natural childbirth gave me a deeper understanding into the meaning of the Bible passage, "But women will be saved through childbearing" (I Tim 2:15) This is not referring to salvation from eternal death, but to something quite different. There are many different interpretations and lines of thought on this passage. But to me it has become clear that God has used the "curse" of the Fall (for man, hard and unproductive labor in their lifework, for women, pain in childbirth) to also be our greatest blessings. Who would deny that men find some of their greatest blessings and self-identity through hard work and discovery/industry/building/etc.? And I know now that women can find some of their deepest grounding, meaning, and self-identity in the pain of childbirth. Our curse has become our blessing.
But frankly, there is just so much to this transformation that I just can't describe it. If anyone would like to write a comment and give me a hint as to what I ought to be writing, I would appreciate it and will add it in! I can only say that natural, drug-free childbirth was an earth-shattering, life-changing transformation that will be with me for the rest of my life. I am even eager to go through it again, just because of that. And I have the deepest sorrow for all the women who do not get to experience this transformation because they have been cut open or drugged. I want every woman to experience this tremendous blessing and transformation - and that's one of the main reasons this blog is here.
Having a baby is more than a messy, unpleasant process that one must endure to get a baby. When people hear a horrible birth story and say, "Well, at least you have a healthy baby! That's what matters!" they completely miss the point. A woman's birth stories are part of her identity and will affect her profoundly for the rest of her life. Many women spend years and subsequent births trying to heal from cruel and demeaning treatment during previous births, or births that were in one way or another traumatic. Yes, the baby is the most important thing, but a mother's birth experience is a close second. There is nothing like it in the world, and I hope to spend the rest of my life promoting natural birth for this reason.
Email me with comments and questions!
Love,
Diana
Thursday, October 9, 2008
A Brief Interlude
As I wrote on my other blog, I'm afraid that both of my blogs have been terribly neglected lately. We're in the busiest time of the year for our family and church (Bible studies, holiday prep, play groups, etc.), and we're also in the middle of a home purchase (it has only taken us 15 months of searching and 11 bids to find one!!). If all goes as planned, we should be moved in before Christmas. Of course, getting our life in order will take much longer. It generally takes me about 3 months to get settled into an apartment (and I've never done it with a toddler before!!), and with unpacking plus yard work (something new!) and home repairs/upkeep (also something new!) I wouldn't be surprised if it took us till June or longer to get really settled down.
Of course, I won't neglect this blog till June! But it may be a bit slow between now and the holidays.
I'm having a bit of confusion as to how I ought to formulate this blog - there is a conflict between the purely "official" - i.e. information, book reviews, statistics, etc., and the personal - my personal journey into the homebirth community. I would like to have a good mix, but I don't know if the two can mix. It'll be interesting to find out.
In terms of my personal journey, I have just been spending a lot of time reading, interacting with the Arizona Birth Network Yahoo! Group (this is a great source of information - try it!!!) and attending birth circle meetings. I haven't yet received the great epiphany into what I am destined to do in the homebirth/childbirth community. I may get the opportunity to participate in a doula training in February, though, and that should be a wonderful source of information and inspiration.
And now I'm off to retrieve some now-incinerated sweet potatoes from the oven! More later!
Of course, I won't neglect this blog till June! But it may be a bit slow between now and the holidays.
I'm having a bit of confusion as to how I ought to formulate this blog - there is a conflict between the purely "official" - i.e. information, book reviews, statistics, etc., and the personal - my personal journey into the homebirth community. I would like to have a good mix, but I don't know if the two can mix. It'll be interesting to find out.
In terms of my personal journey, I have just been spending a lot of time reading, interacting with the Arizona Birth Network Yahoo! Group (this is a great source of information - try it!!!) and attending birth circle meetings. I haven't yet received the great epiphany into what I am destined to do in the homebirth/childbirth community. I may get the opportunity to participate in a doula training in February, though, and that should be a wonderful source of information and inspiration.
And now I'm off to retrieve some now-incinerated sweet potatoes from the oven! More later!
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